Healthcare Provider Details

I. General information

NPI: 1871830752
Provider Name (Legal Business Name): LAURY J DIMICK LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAURY KUDER

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HOLLY LANE
SALINA KS
67401
US

IV. Provider business mailing address

730 HOLLY LANE
SALINA KS
67401
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-4930
  • Fax: 785-452-4932
Mailing address:
  • Phone: 785-452-4930
  • Fax: 785-452-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4436
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: